CAN-EUG-75

Code
CAN-EUG-75
Mercy ID
V-02481-01
Encounter Date
05/02/2007
Last
Canales
First
Eugenia
DOB
12/05/1975
County
Dekalb
Street
3510 Buford Hwy.
City
Atlanta
State
GA
Zip
30329-
Home
(404) 396-0780
Other
(404) 396-0780
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Shelter
Education Level
Grade school

Spouse Information

Last
Rivera
First
Joel
DOB
09/12/1982
Address
N/A
Telephone
(678) 330-4161
COB
Honduras
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
YES
Consentimiento De Participar
YES

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Jennifer Rivera 04/14/2005 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
PADV-Jeannette Handy